We do love it when someone refers a family member or friend to us. Sometimes the question is, “How can we introduce them to you?” Well, there are multiple ways but a very easy way is to simply forward them a link to this webpage.
Here are this week’s items:
5 Things to Know About Medicare Advantage Open Enrollment Period for Retirement
Radon and Murs discuss the complexities of the Medicare Advantage Open Enrollment Period with Shawn Southard, the Medicare aficionado at Peace of Mind Wealth Management. Listen in to learn about the differences between Medicare Advantage and original Medicare, how to navigate maximum out-of-pocket costs, and what to look for when considering switching plans…..
5 Things to Know About Medicare Advantage Open Enrollment Period for Retirement
Medicare Advantage Open Enrollment is an essential period for anyone currently enrolled in Medicare Advantage plans or considering switching plans. This period, which runs annually from January 1 to March 31, provides an opportunity to reassess your healthcare coverage and make changes if necessary. To help you navigate this critical time, we’ve outlined five important aspects of the Medicare Advantage Open Enrollment Period (OEP).…..
Medicare Advantage Open Enrollment is an essential period for anyone currently enrolled in Medicare Advantage plans or considering switching plans. This period, which runs annually from January 1 to March 31, provides an opportunity to reassess your healthcare coverage and make changes if necessary. To help you navigate this critical time, we’ve outlined five important aspects of the Medicare Advantage Open Enrollment Period (OEP). By the end of this article, you’ll have a clearer understanding of how this enrollment period works and how to make the best decisions for your healthcare needs.
1. What Is Medicare Advantage Open Enrollment?
The Medicare Advantage Open Enrollment Period allows beneficiaries currently enrolled in Medicare Advantage plans to make one change to their coverage. This change could include:
Switching from one Medicare Advantage plan to another (with or without prescription drug coverage).
Disenrolling from a Medicare Advantage plan and returning to Original Medicare (Parts A and B), with the option to enroll in a Medigap policy and a standalone Prescription Drug Plan (Part D).
This flexibility makes it easier for beneficiaries to address any issues they’ve encountered with their current plan, such as unexpected costs or network restrictions. Unlike the Medicare Annual Enrollment Period (October 15 to December 7), which is open to all Medicare beneficiaries, the OEP is limited to those already enrolled in Medicare Advantage plans.
There are several common reasons why Medicare beneficiaries consider changing plans during the OEP:
Prescription Drug Coverage Issues: Many beneficiaries discover in January that their plan’s formulary—the list of covered prescription drugs—does not align well with their medication needs. This mismatch can lead to higher out-of-pocket costs or difficulty accessing necessary medications.
Network Limitations: Medicare Advantage plans often operate as either Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). HMOs generally have smaller networks, requiring members to see in-network providers. PPOs offer more flexibility, allowing for out-of-network care at higher costs. Beneficiaries dissatisfied with their current network may switch to a plan with a broader or more suitable provider network.
Additional Benefits: Some Medicare Advantage plans offer extra benefits like dental, vision, hearing, or fitness programs. Beneficiaries seeking better or more comprehensive ancillary benefits may switch plans during this period.
While the Medicare Advantage Open Enrollment Period provides valuable flexibility, there are pitfalls to avoid, particularly when switching back to Original Medicare:
Medigap Underwriting: If you disenroll from a Medicare Advantage plan and return to Original Medicare, you’ll likely want to purchase a Medigap policy to cover out-of-pocket costs like copays and coinsurance. However, unless you’re in your initial six-month Medigap Open Enrollment Period or qualify for a special trial right, you may need to undergo medical underwriting to obtain a Medigap policy. This means your application could be denied based on your health.
Gaps in Coverage: Without a Medigap policy, you’ll be responsible for covering significant out-of-pocket costs under Original Medicare. Ensure you have a strategy in place to cover these gaps before disenrolling from your Medicare Advantage plan.
When deciding whether to make a change during the Medicare Advantage Open Enrollment Period, keep these factors in mind:
Maximum Out-of-Pocket Costs (MOOP): Each Medicare Advantage plan has a MOOP limit, which is the maximum amount you’ll pay out of pocket for covered services during the year. High MOOP limits can significantly impact your budget, especially if you require extensive medical care. Review your plan’s MOOP and compare it to other available options.
Coverage for Serious Illnesses: Medicare Advantage plans often include a 20% coinsurance clause for treatments like chemotherapy. Ensure you understand how your plan handles these costs and how they count toward your MOOP.
Prescription Drug Coverage: Evaluate how your plan covers your medications and consider whether switching plans could lower your out-of-pocket costs for prescription drugs.
5. Tips for Navigating the OEP
Navigating the Medicare Advantage Open Enrollment Period can be overwhelming, but these tips can simplify the process:
Review Your Current Plan: Start by understanding your current plan’s benefits, costs, and network restrictions. Identify any areas where your plan falls short.
Compare Available Plans: Use Medicare’s Plan Finder tool or consult with a licensed Medicare advisor to compare plans in your area. Focus on coverage for prescription drugs, network access, and out-of-pocket costs.
Consult a Professional: Medicare Advantage plans are complex, and working with a knowledgeable advisor can help you make an informed decision. Advisors can provide personalized recommendations based on your healthcare needs and financial situation.
Conclusion
The Medicare Advantage Open Enrollment Period is an important time for beneficiaries to reassess their healthcare coverage and adjust if needed. Whether you’re looking to switch plans, address prescription drug coverage issues, or transition back to Original Medicare, understanding the nuances of this period can help you make informed choices.
If you have any questions on Medicare, we’d like to speak with you. Schedule your complimentary 15 minute call with us and learn more about “5 Things to Know About Medicare Advantage Open Enrollment Period.”
We do love it when someone refers a family member or friend to us. Sometimes the question is, “How can we introduce them to you?” Well, there are multiple ways but a very easy way is to simply forward them a link to this webpage.
Here are this week’s items:
Portfolio Update: Murs and I have recorded our portfolio update for January 8, 2024
Understanding Medicare Advantage Open Enrollment in Retirement
In this Episode of the Secure Your Retirement Podcast, Radon and Murs have our in-house Medicare specialist, Shawn Southard, discuss the Medicare Advantage open enrollment. With an education background and a servant’s heart, Shawn is passionate about helping people find the right Medicare plans. Listen in to learn about the benefits of a Medicare Advantage plan and the reasons for the Medicare Advantage open enrollment period.
Understanding Medicare Advantage Open Enrollment in Retirement
Medicare is such an important part of your life as you age and secure your retirement, but it’s often overlooked in retirement planning. You may have to pay IRMAA surcharges and really need to begin planning to get the most out of your benefits. We’re happy to have had Shawn Southard on our podcast this past week to discuss Medicare Advantage Open and what it means for our listeners and clients.
Medicare is such an important part of your life as you age and secure your retirement, but it’s often overlooked in retirement planning. You may have to pay IRMAA surcharges and really need to begin planning to get the most out of your benefits.
We’re happy to have had Shawn Southard on our podcast this past week to discuss Medicare Advantage Open and what it means for our listeners and clients. Shawn works in-house for us and will be helping all our clients with their Medicare needs.
Throughout the year, there are a lot of Medicare-related things that pop up that we really need to focus on.
Note: Every month, we plan on having Shawn on the show to discuss questions that our listeners may have.
Medicare Open Enrollment Period
Medicare has quite a few enrollment periods that are easy to overlook. You can enroll when:
You turn 65 years old
You’re working past 65, retire and leave your health plan.
Annually, from October 15 – December 7 (this is when 95% of beneficiaries make changes to their plans)
January 1 – March 31st for Medicare Advantage policyholders, who can change plans or disenroll if they wish.
Medicare Advantage Open enrollment is what anyone reading this blog or who watched our episode will need to think about in January until the end of March.
What is a Medicare Advantage Plan?
Medicare Advantage plans, at a very high level, are often organized into parts by letters. But before we go into that, original Medicare is broken into:
Part A: Hospital coverage
Part B: Medical coverage
Part D: Prescription Drug coverage, optional but will incur lifetime penalty if not enrolled when eligible.
Part C is the Medicare Advantage plan. Medicare Advantage helps round out your Medicare. These are private plans that go through the insurance companies and are approved by Medicare. Each plan must offer the same Part A and B coverage as your original Medicare plan, but it is a private plan.
The Advantage plan offers additional benefits, such as:
Preventative Dental
Preventative Vision
Hearing Exams
An Advantage plan may also combine your prescription coverage into the plan, but you’ll need to review each plan to learn more about the coverage offered.
Why Join a Medicare Advantage Plan Over Original Medicare?
A lot of you may be thinking, “Why would I switch from original Medicare to an Advantage plan?” One of the main reasons to make the switch is that original Medicare is only for things that are deemed medically necessary.
Medicare Advantage plans add in coverage for:
Annual physical exams
Dental cleanings
Eye exams
Hearing exams
Original Medicare plus a Medigap plan is an option, but this option comes with a premium that ranges from $130 – $150 per month.
Medicare Advantage has many great plans that have $0 premiums.
For a retiree, an Advantage plan often makes a lot of sense because they’re on a fixed income.
Why Someone May Not Choose a Medicare Advantage Plan
Advantage plans seem very advantageous, but they’re also not for everyone. A downside of Medicare Advantage is that they are network plans:
Health Maintenance Organizations (HMOs), smaller network
You’ll need to go to someone in your network if you have an Advantage Plan. Original Medicare doesn’t have networks, so it’s easier for you to travel. You don’t need to worry about the provider being in network as long as they accept Medicare.
Medicare Advantage HMO requires you to stay in network. A PPO does have out-of-network options, but you may pay more for the services.
You need to consider the following when choosing a Medicare path (Original Medicare/Medigap or MedAdvantage):
Health
Lifestyle
Budget
Medicare is complex, and it’s easy to make a costly mistake along the way because of the amount of misinformation that exists. It is in your best interest to consult with a Medicare specialist before making any changes to your plan.
Why Someone May Want to Switch Medicare Advantage Plans
Since we’re in the enrollment period where someone can switch Medicare Advantage plans, the question arises: why would you switch plans?
Often, a person wants to switch Advantage plans because:
Doctors that they have been going to are no longer in their network, so they switch to a plan that allows them to retain the same doctor that they know and trust.
They plan to move and the new service area does not have their providers in network.
Shawn helps our clients choose the right plan for their medical needs and lifestyles. He has a strong educational background as a high school teacher and corporate trainer. In fact, his background as an educator is why he joined our team. He aims to educate each client, based on their individual needs, to find the best Medicare path.
Shawn needs to know your health/medical conditions, any prescription drugs you are taking, and your lifestyle (such as traveling) to help you select the right type of Medicare plan for you.
Medicare is complex – especially if it’s not something you work with every day.
If you want to have an in-depth discussion about your Medicare situation and ensure that you’re on the right pathway, feel free to reach out to Shawn.